IDAHO FACIAL IMAGING LLC
Radiology at Ustick Rd, Boise, ID

License number
Idaho 4-D-2095
Category
Ambulatory Health
Type
Radiology
Owner
Name: DR. BRADEN M STAUTS DDS
Title: OWNER/PARTNER
Phone: (208) 514-4740
Address
Address
8119 Ustick Rd SUITE 101, Boise, ID 83704
National Provider ID: 1437178399
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about IDAHO FACIAL IMAGING LLC at bizstanding.com

IDAHO FACIAL IMAGING, LLC

8119 Ustick, Boise, ID 83704

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Idaho Facial Imaging
Registration:
Sep 22, 2005
Inactive since:
Dec 24, 2014
Phone:
(208) 514-4740 (Phone)
State ID:
W43091
Business type:
Limited Liability Company
Owner, Partner, Principal:
Braden M. Stauts (Owner, Partner, Principal)
Agent:
Gery W Edson,250 S 5 St STE 820, Boise, ID 83701 (Physical)
Categories:
Beauty Salons, Physicians & Surgeons, Radiology Physicians & Surgeons, ...

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